Blog
About

20
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A training package for zone III Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

      , 1 , 1 , 2 , 1

      Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

      BioMed Central

      London Trauma Conference 2013

      10-13 December 2013

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background Non-compressible haemorrhage is the leading cause of preventable trauma death, with pelvic and groin haemorrhage associated with mortality rates approaching 50% [1,2]. Trauma systems expedite access to haemorrhage control, however, the majority of patients who die, exsanguinate before control can be achieved. REBOA is an innovative technique that provides the opportunity for meaningful improvements in the outcome of these patients. It involves the positioning of a balloon at the aortic bifurcation (Zone III) as a means of temporary in-flow control and afterload augmentation in patients with severe distal haemorrhage [3]. Our aim is to describe the training package developed to introduce zone III REBOA at a UK Major Trauma Centre. Methods A multidisciplinary working group, consisting of consultants in Pre-Hospital Care, Emergency Medicine, Interventional Radiology, Anaesthesia and Trauma and Vascular Surgery, reviewed the existing REBOA literature and developed a training package that enables procedural knowledge and competence in potential operators. Results The REBOA training package components are: 1) Required reading Consists of six publications that detail the background, benefits, technical considerations and worldwide experience with the procedure. 2) Standard operating procedure (SOP) An evidence-based SOP defines the target population, equipment, procedure and post-procedure management. 3) Written assessment A written assessment, based on the required reading and SOP, tests trainees’ knowledge and understanding of the procedure. 4) Equipment familiarisation A purpose built mannequin and complete set of training equipment allow trainees to gain technical familiarity with procedural steps and kit. 5) Moulage Scripted scenarios are used in multidisciplinary, high fidelity, training “moulages” to test the trainees’ leadership, decision-making, teamwork and procedural competence. 6) “Sign-off” Potential operators are required to successfully complete all components of the training package under the supervision of a “signed-off” operator. Conclusion REBOA is less invasive and more effective at temporarily controlling exsanguinating pelvic haemorrhage than thoracotomy with aortic compression. As with resuscitative thoracotomy, many clinicians faced with a patient who would benefit from the procedure, will have no prior experience with REBOA. Our training package attempts to address this.

          Related collections

          Most cited references 2

          • Record: found
          • Abstract: not found
          • Article: not found

          Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock.

            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Epidemiology and outcome of vascular trauma at a British Major Trauma Centre.

            In the United Kingdom, the epidemiology, management strategies and outcomes from vascular trauma are unknown. The aim of this study was to describe the vascular trauma experience of a British Trauma Centre. A retrospective observational study of all patients admitted to hospital with traumatic vascular injury between 2005 and 2010. Vascular injuries were present in 256 patients (4.4%) of the 5823 total trauma admissions. Penetrating trauma caused 135 (53%) vascular injuries whilst the remainder resulted from blunt trauma. Compared to penetrating vascular trauma, patients with blunt trauma were more severely injured (median ISS 29 [18-38] vs. ISS 11 [9-17], p < 0.0001), had greater mortality (26% vs. 10%; OR 3.0, 95% CI 1.5-5.9; p < 0.01) and higher limb amputation rates (12% vs. 0%; p < 0.0001). Blunt vascular trauma patients were also twice as likely to require a massive blood transfusion (48% vs. 25%; p = 0.0002) and had a five-fold longer hospital length of stay (median 35 days (15-58) vs. 7 (4-13), p<0.0001) and critical care stay (median 5 days (0-11) vs. 0 (0-2), p < 0.0001) compared to patients with penetrating trauma. Multivariate regression analysis showed that age, ISS, shock and zone of injury were independent predictors of death following vascular trauma. Traumatic vascular injury accounts for 4% of admissions to a British Trauma Centre. These patients are severely injured with high mortality and morbidity, and place a significant demand on hospital resources. Integration of vascular services with regional trauma systems will be an essential part of current efforts to improve trauma care in the UK. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
              Bookmark

              Author and article information

              Contributors
              Conference
              Scand J Trauma Resusc Emerg Med
              Scand J Trauma Resusc Emerg Med
              Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
              BioMed Central
              1757-7241
              2014
              7 July 2014
              : 22
              : Suppl 1
              : P18
              Affiliations
              [1 ]London’s Air Ambulance, The Royal London Hospital, London, UK
              [2 ]Centre for Trauma Sciences, Queen Mary, University of London, UK
              Article
              1757-7241-22-S1-P18
              10.1186/1757-7241-22-S1-P18
              4123223
              Copyright © 2014 Lendrum et al; licensee BioMed Central Ltd.

              This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

              London Trauma Conference 2013
              London, UK
              10-13 December 2013
              Categories
              Poster Presentation

              Emergency medicine & Trauma

              Comments

              Comment on this article